Advertisement

Successful ventricular tachycardia ablation in a patient with limited vascular and left ventricular endocardial access due to multiple mechanical cardiac support devices

      Abstract

      A 48-year-old male with ischemic cardiomyopathy was admitted because of cardiogenic shock due to incessant ventricular tachycardia (VT). Despite the introduction of multiple mechanical cardiac support (MCS) devices, his hemodynamics were unstable; therefore, VT ablation was performed. Due to the limited vascular and left ventricle (LV) access with the multiple MCS devices, only the left femoral artery and vein were accessible. In addition, the transseptal approach as an LV access was difficult because of the MitraClip (Abbott Park, IL, USA). Posterior papillary muscle-origin VT was successfully treated via a transaortic approach under the MCS. After the VT ablation, the patient recovered from the MCS.

      Learning objective

      Mechanical cardiac support (MCS) devices are critical during ventricular tachycardia (VT) ablation in patients with left ventricular (LV) dysfunction. However, the ablation strategy for cases with limited access due to multiple MCS devices has not been established. In this case, VT was successfully treated via a transaortic approach using intracardiac echocardiography. The number of cases requiring VT ablation for patients with limited vascular and LV endocardial access would increase; therefore, the accumulation of those cases is required to find a better strategy.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Cardiology Cases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Haegeli L.M.
        • D'Angelo G.
        • Trevisi N.
        • Stella S.
        • Breitenstein A.
        • Duru F.
        • Brunckhorst C.
        • Della Bella P.
        Catheter ablation of ventricular tachycardia in patients with MitraClip device: preliminary findings.
        J Cardiovasc Electrophysiol. 2017; 28: 523-530
        • Aryana A.
        • Gearoid O'Neill P.
        • Gregory D.
        • Scotti D.
        • Bailey S.
        • Brunton S.
        • Chang M.
        • d'Avila A.
        Procedural and clinical outcomes after catheter ablation of unstable ventricular tachycardia supported by a percutaneous left ventricular assist device.
        Heart Rhythm. 2014; 11: 1122-1130
        • Guandalini G.S.
        • Liang J.J.
        • Marchlinski F.E.
        Ventricular tachycardia ablation: past, present, and future perspectives.
        JACC Clin Electrophysiol. 2019; 5: 1363-1383